What is pre-eclampsia characterised by:
- multisystem involvement
- hypertensino of at least 140/90 on 2 seperate occasions 4 hours apart
- occurs at 20 weeks + gestation
- resolves within 6 weeks postnatal
- sigmificant cause of maternal and foetal morbidity
complications of pre-eclampsia
eclampsia
HELLP syndrome
risk factors for Pre-eclampsia
first pregnancy
Multiple pregnancies (twins?)
Donor eggs/ embryo
Previous bistro of pre-eclampsia
BMI >35
>40 years of age
Pregnancy interval >10 years
Underlying medical conditions: e.g., DM, renal disease, hypertension
what is pre-eclampsia
a hypertensive disorder of pregnancy caused by abnormal placentation leading to a maternal inflammatory response
are women asympotmatic
if women are asympotmatic, how are most diagnosed?
routine antenatal screening
classification of pre
Chronic hypertension
PIH (pregnancy induced hyopertension)
PIH + proteinuria
Proteinuria w/ hypertension
Pathophysiology
- Impaired trophoblast invasion (causes vasospasm) + spiral artery remodelling
- Decreased utero-placental perfusion
- Placental hypoxia
- Decreased NO and prostaglandin oroduction (lack of vasodilators)
- Decreased angiogenesis and endothelial dysfunction
multi system effects
eclampsia
hypertension
cardiomyopathy
increased RAAS sensitivity
thrombocytopaenia
pulmonary oedema
neurological effects- fitz
signs
clonus
hyperreflexia
platelets <100
creatinine > 200
ALT > 50
haemolysis (drop in Hb)
symptoms
headache
nausea and vomiting
oedema
epigastric pain
oligiuria
investigations for diagnosis
- BP > 140/90—— BP usually falls in pregnancy
- urine analysis- dip for proteinuria
- Bloods- FBC, dotting profile, LFTs and U+E
prevention
primary prevention can’t be done as the cause is unknown
secondary prevention: heparin reduces recurrance for women w thrombophilia
tertiary prevention: good antenatal care and surveilance
prediction methods for pre-eclampsia
angiogenic factor (sFIlt)- prediction from urinary test
PIGF- placental growth factor synthesised by syncitiotrophoblasts. reduced levels are predictive of PET (pre-eclampsia toxaemia)
Drugs used in treatment
- Anti-hypertensives- to control high blood pressure —-hydralazine?
- To reduce risk of seizures—- magnesium sulphate
- Steroids (dexamthesone) to help the foetus lung formation
Management
MDT involvement
Fluid restriction
Observation (BP/ pulse/ RR/ urine output/ reflexes)
Bloods, biochemistry and urinary protein monitoring
Drugs (antihypertensives, magnesium sulphate, steroids)
Foetal monitoring (mother takes priority over foetus)
Delivery and follow up
Vaginal or caesarean section (depending on gestation and severity)
Epidural vs. general anaesthesia
Post-partum haemorrhage treatment
Continue mag sulph for 24 hours
Monitor bloods and biochem
Monitor BP
Consider venousthromboembolism prophylaxis when safe to do so
Arrange follow up
Variants of pre-eclampsia toxaemia
Eclampsia
- Seisures
- Mortality
- Obstetric emergency
- Mag sulph IV
- Stabilise mother and deliver
HELLP
Haemolysis
elevated liver enzymes
low platelets
results from endothelial damage
risk of disseminated intravascaulr coagulation
